Suicidal behavior among people with epilepsy in Northwest Ethiopia: A comparative cross-sectional study Tesfa Mekonen a,b, ⁎, Asmamaw Getnet c , Amsalu Belete d , Melak Menberu a , Wubalem Fekadu a,e a Psychiatry Department, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia b School of Psychology, University of Queensland, Australia c College of Health Sciences, Debre Markos University, Ethiopia d College of Medicine and Health Sciences, Debre Tabor University, Ethiopia e Department of Psychiatry, College of Health Sciences, Addis Ababa University, Ethiopia abstract article info Article history: Received 9 January 2020 Revised 6 May 2020 Accepted 5 June 2020 Available online 18 June 2020 Introduction: Premature mortality is common in people with epilepsy, but the causes vary where suicide is considered as one of the commonest. Objective: The objective of this study was to compare suicidal behavior between people with epilepsy and the general population and identify associated factors in Northwest Ethiopia. Methods: We have conducted a comparative cross-sectional study in Northwest Ethiopia. We have selected people with epilepsy from outpatient departments and the comparisons from the general population. Suicidal behavior was assessed by the revised version of Suicidal Behaviors Questionnaire (SBQ-R). Logistic regression was implemented to look for associations between factors and the dependent variable. Results: The prevalence of suicidal behavior in people with epilepsy was 18.2%, significantly higher than the com- munity sample, which was 9.8% (p-value = .001). This difference persists in the multivariable logistic regression model by which the odds of suicidal behavior in people with epilepsy was two times more as compared to the community sample. Other variables positively associated with suicidal behavior for the overall sample were de- pressive symptoms, no formal education, divorced/widowed marital status, and higher perceived criticism. Better social support was protective factor for suicidal behavior. Conclusion: The proportion of suicidal behavior is twofold higher in people with epilepsy than the general population. Routine screening for suicide risk should be an integral part of epilepsy treatment. © 2020 Elsevier Inc. All rights reserved. Keywords: Epilepsy Suicidal behavior Suicide Comparative study Ethiopia 1. Introduction Suicide is defined as intentionally ending one's own life while suicidal behavior is a nonfatal form that comprises suicidal ideation, suicidal plan, and suicidal attempt [1]. Suicidal behavior, especially suicidal attempt is an important predictor for completed suicide [2]. Most suicides are believed to occur becaus of neuropsychiatric and substance use disorders where epilepsy takes a significant share [3]. People with epilepsy die prematurely compared to the general population (8.8% vs 0.7%). After adjusting for social and demographic factors, people with epilepsy were 11 times more likely to die prematurely compared with people who did not have the illness [4]. This is true even during remission where people in remission have more than twice odds to dying earlier compared to the general population [5,6]. Suicide may be the major cause of this premature mortality, with approximately 4 times increased risk as compared to the general population [4]. The magnitude of suicidal behavior among people with epilepsy is ranged from 13.3%–40.3% in different areas and contexts [7–10]. It is a complex phenomenon mediated by multiple factors. Comorbidity of depression with epilepsy is one of the significant factors that increase the risk [11]. Sleep disturbance, female gender, unemployment, poor quality of life, and poor seizure control are also associated with increased risk of suicide [8,9,12]. Though there is an important linkage between suicidal behavior and epilepsy, the factors that affect the linkage are still not exhaustively studied [13]. In Ethiopia, there is a reasonable and growing body of literature addressing the suicidal behavior of psychiatric outpatient service consumers and the general population [3,14,15]. However, there is a scarcity of publications addressing suicidal behavior and peo- ple with epilepsy [16]. Moreover, the association of some important fac- tors such as emotional involvement of family members and suicidal behavior is either not well studied or not clear yet. Therefore, the objec- tives of this study were as follows: Epilepsy & Behavior 111 (2020) 107233 ⁎ Corresponding author at: Psychiatry Department, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia. E-mail address: smarthope1@gmail.com (T. Mekonen). https://doi.org/10.1016/j.yebeh.2020.107233 1525-5050/© 2020 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh